I discuss issues pertaining to the practice of neuropathology -- including nervous system tumors, neuroanatomy, neurodegenerative disease, muscle and nerve disorders, ophthalmologic pathology, neuro trivia, neuropathology gossip, job listings and anything else that might be of interest to a blue-collar neuropathologist.

Tuesday, February 26, 2013

Review by Dr. Mark Cohen of "Neuropathology: A Volume in the High Yield Pathology Series", edited by Yachnis and Rivera-Zengotita

Mark L. Cohen, MD

I am honored to present a guest post by the inimitable Dr. Mark Cohen of the illustrious Case Western Reserve University. Dr. Cohen not only reviews a great new neuropathology textbook, but illustrates yet again why he is widely known as the Maxwell Smart of Neuropathology.

(Not really) Full disclosure

Self-annihilating conflicts of interest, as follows:

Long-standing
professional relationship with unbridled admiration for lead editor Tony Yachnis,
both as a person and as a pathologist (he's not the Moderator of the
world-famous Diagnostic Slides Session of the American Association of
Neuropathologists, as well as their President-Elect, for nothing).

I
have contributed to several publications that compete within the same
niche, and from which I have amassed a small fortune (recently enabling me
to purchase new windshield wipers for my ‘99 Corolla).

Several weeks ago, I received the following teaching
evaluation from an anonymous medical student: "One of the worst lecturers
that I had the misfortune of experiencing in medical school. Powerpoints were
poorly constructed in terms of high yield content...”. So, when our host Dr.
Moore blogged about the impending publication of Neuropathology: A Volume in the High Yield Pathology Series, I
sprinted to my laptop to pre-order a copy.

Anthony T. Yachnis, MD, MS

The book arrived safely last night (albeit buried in
several inches of snow), and I was not disappointed. Best described as Text-Atlas,
it weighs in at 351 pages, which is roughly half that of both Perry & Brat’s Practical Surgical Neuropathology
and Prayson’s Neuropathology, second edition. In addition, it represents something of a revolutionary approach in
that it was primarily written by trainees in pathology, neuropathology,
dermatopathology, hematopathology and neurosurgery. This team-based approach (a
testament to Captain Tony’s coaching skills) has produced a neuropathology text
“of the people, by the people, and for the people”, as well as resulting in a textbook
which is remarkably up to date (including such topics as Natalizumab-related
PML). In addition to an introduction to basic neuropathological reactions,
subjects covered include developmental disorders (both malformative and
acquired), cerebrovascular disorders, trauma, brain tumors, infectious
diseases, neurodegenerative disorders, demyelinating diseases, toxic/metabolic
disorders, and neuromuscular disorders. For a book of this size, the scope of
the topics covered is remarkably comprehensive, and they are extensively, if
not exhaustively, illustrated. The pictures, especially the gross photographs,
are of uniformly high quality (which appears to be maintained in the on-line version,
unlike another high-profile textbook I reviewed a few years ago). In addition
to the beautifully photographed gross specimens, pictures include
histochemistry, immunohistochemistry, and neuroimaging, as appropriate. The
vast majority of the photographs are reproduced at 3.25 x 2.5 inches, which is
more than adequate to appreciate the features described in the figure legends.
With rare exceptions, arrows are not
included within the photomicrographs (which I feel is appropriate, but has gotten
me in trouble with certain journals, publishers, and students). As is the
practice within this series of textbooks, as well as in many other currently
published pathology books, the text is entirely bulleted (a practice which I
personally dislike, but which is executed quite well here). Another feature
that the reader should be aware of is that (no doubt as part of the philosophy
of “high-yield pathology”) there are no references.

Marie Rivera-Zengotita, MD

As an academic neuropathologist, do I have criticisms?
(Do bears sh...?). Besides minor quibbles with organization (I probably would have
included Natilizumab-associated PML within the Infections section rather than as part of multiple sclerosis) and
such Talmudic issues as whether brain invasive meningiomas are truly atypical
or not really atypical, but still WHO Grade II, I think that the improvements
that I would suggest are largely outside the purview of the authors and
editors. Specifically, the titling typography and design layout is nothing
short of hideous, and, although the pictures are of adequate size, the presence
of many nearly blank pages certainly makes me wish that those spaces had been
filled by larger format photographs. In addition, a few of the topics are
presented sans photographs, which detracts
somewhat from the flow of the textbook (although the authors had the good sense
of not trying to illustrate mixed oligoastrocytomas). All in all, however, I
think that the book succeeds in its aspirations of presenting "high yield
neuropathology".

The editors hope that the volume will be useful for
trainees in pathology, neurology, neurosurgery, neuroradiology, neuro-oncology
and related fields; as well as being a practical reference for practicing pathologists
-- including neuropathologists requiring quick access to the field. As I was
reading through the text, I kept this in mind, and triaged these groups as
follows:

Neurology
and neurosurgery residents should run, not walk, to order a copy, as Board
examinations are near at hand, and this book provides a perfect study
guide for preparation. Neuropathology fellows should also obtain a copy
for studying, although at this moment they have time to walk to their laptops
or bookstore.

Neuroradiologists
and anatomic pathologists should obtain a copy to keep as a quick
reference

As
far as practicing neuropathologists go, I think we all need a copy as we
generally find ourselves in one of two situations:

A
private practice or group setting without instantaneous access to
literature databases. For this group, I think the book fulfills its goal
as a quick access to diseases with which we may have become unacquainted during
our time in practice.

A
large academic medical center with
broadband access to literature databases. In this position, our quick
access will generally be on-line. On the other hand, we should all have a
copy to lend to clinical rotators as an expression of our great goodwill.
(Another minor weakness of the book is that there is no RFID device by
which we can geolocate our books once they have left our offices. On the
other hand, the included on-line access assures that even as our copies
disappear, we will still have access from our computers).

Unfortunately, while I feel this book will definitely help
to guide me in the revision of my medical student lectures, it is by itself not
appropriate for medical student study. To paraphrase Jack Nicholson as Col
Nathan R. Jessup, USMC in A Few Good Men: You want high yield? You can’t handle high-yield!

Luckily, for those who can handle the truth, Neuropathology: A Volume in the High Yield
Pathology Series will provide a valuable and lasting resource.